National treatment trends among older patients with T1-localized renal cell carcinoma

Objective To assess the national trends in treatment of localized renal tumors among older patients with limited life expectancy. Materials and methods Using the National Cancer Database, we identified older patients (≥70 y) diagnosed with T1 renal cell carcinoma from 2002 to 2011. Primary outcome was the initial treatment—partial nephrectomy (PN), radical nephrectomy, EM, and ablation. Multivariable logistic regression analysis stratified by tumor size (<2, 2–3.9, or 4–7 cm) and age groups (70–79 and ≥80 y) was used to identify covariates associated with different treatments. Results Among 41,518 older patients with T1 renal cell carcinoma renal tumors, most were treated with radical nephrectomy (59.0%) followed by PN (20.0%) and ablation (8.4%). Only 12.6% were managed by EM. Among older patients aged 70 to 79 years with renal tumors 2 to 3.9 cm, PN was used more frequently in 2008 to 2009 (odds ratio [OR] = 1.32; P = 0.001) and 2010 to 2011 (OR = 1.87; P<0.001) compared to 2002 to 2003 and at academic hospitals (OR = 1.91; P<0.001) compared to community hospitals. Similar trends were observed for patients aged 70 to 79 years with 4 to 7 cm tumors and for patients aged≥80 years across renal tumor sizes. Conclusions Among older patients with localized renal tumors and limited life expectancy, most are treated surgically with a growing use of PN. A smaller proportion of older patients are managed by EM in the United States.